Mental Health

What's It All About, Alfie?

Psychosis

Schizophrenia

Schizophrenia is super common (about 1 in 200 - that's common in medical terms) and yet so poorly understood by the public. It's a real shame, because people with schizophrenia can be exceptionally vulnerable. This means that they often get abused and taken advantage of. Sometimes this can come from people who are well-meaning, but just do not understand the condition.

Much of the portrayal of schizophrenia in the media is negative and misconstrued. It is used as a tool in the horror genre, it is used as an excuse for plot twists, and regularly portrayed as a condition within which the individual has no control over their actions. This is, of course, not true. I hope that one day we can break down the barriers surrounding the public perception of schizophrenia, and help to educate everyone about this fascinating and often debilitating condition, and to come together to help the millions who live every day of their life with it.

Many people consider schizophrenia to be a form of "split personality" or just "hearing voices". In fact it is a fascinating multi-faceted state of mind which we do not yet fully understand. The main summary is that it describes a state where the individual finds it difficult tell what is real, and what is not real. They may also be unable to think properly. Commonly it includes the following features, but not necessarily all of them. They may or may not be aware that these things are happening and that they are not real.

Hallucinations

Hallucinations are a disturbance in perception. This can involve any sense. Auditory hallucinations are the most common and it is usually voices. The voices can be inside or outside the head, they can be people they know or strangers, young, old, or one or many people. They may tell the individual what to do or say derogatory things and can be quite distressing.

Visual hallucinations involve seeing things that aren't there. Tactile hallucinations are feelings of things that aren't there - commonly worms/bugs under the skin. Olfactory and gustatory hallucinations are smells and tastes respectively. Hallucinations of taste and smell aren't super common in schizophrenia but do happen - they are actually much more common in epilepsy.

Delusions

Delusions are a false belief is something that literally cannot be, or is highly unlikely to be true. By definition a delusion is fixed, and trying to rationalise it away will not work. Often the individual will say something like, "I cannot say how this is true, or why. I just know it is."

For a belief to be classified as a delusion it must be outside the realms of social, cultural and religious norms.

This belief can be anything. Broadly speaking they are either bizarre (cannot be true) or non-bizarre (could be true but are not), and they can either be mood congruent (for example a patient with mania thinking they are superman) or not. However, there are more common delusions and we are able to categorise them into themes:

Persecutory: The person believes they are being treated wrongly in some way and that the perpetrater intends to cause harm. This can mean they believe they are being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, etc. This could be by people they know, or people they don't. It is commonly neighbours and police. It is also sometimes healthcare professionals.

Guilt: The belief that they are responsible for events and crimes that they could not possibly have had anything to do with - for example wars in other countries or natural disasters. They may attribute this to a particular act; "The flood hit because I touched a yellow cup."

Grandiose: The belief they have knowledge or abilities that are out of proportion with their own level of experience and expertise, or even to the extent of being superhuman. For example, that they have superpowers, healing abilities, high qualifications (doctor, lecturer, government agent, military personel). They may believe they are immortal and put their lives in danger to prove it.

Reference: The belief that the TV or radio or another external broadcasting medium is communicating specifically to them. An alternative is that objects and actions of others have specific meanings which are completely false - like, "That dog barked, which means I must turn the lights off and on."

Erotomania: The belief that the individual is loved by someone they have never met, have minimal contact with, or is patently not in love with them. Commonly celebrities.

There are more, but they are not very common.

Thought Disorder

Psychosis often comes with disturbances to the way the person is able to think. This may mean thoughts get "blocked" on their way around the brain. They may be "tangential" and move from one topic to another very quickly, often without an obvious link. They may be very pressured and have lots of thoughts they want to get out at once, or they may be switching from subject to subject so quickly that it is not even possible to follow what they are saying.

There are also delusions around thoughts - thought broadcast is the belief ones thoughts are being said aloud. Thought insertion is the belief that an outside force or individual is physically inserting thoughts into the person's brain that are not their's. And thought withdrawal is the belief that thoughts are forcibly being removed.

Drug-Induced Psychosis

Many stimulating drugs can obscure the line between the conscious and subconscious mind and cause the user to have perceptual experiences. Hallucinogenic drugs have this effect. It is often self-limiting.

Sometimes people can remain psychotic for days after using the drug and suffer until it is out of their system. Occasionally they need to be in hospital during this period for their safety.

Other types of psychosis

The manic phase of bipolar disorder often characterises with psychotic features as listed above. Particularly common are grandiose delusions and flight of ideas - meaning the person thinks very quickly and jumps from one topic to another without an obvious link.

Major depression can involve psychotic features also. The most common ones are delusions of guilt or nihilistic delusions - the belief that they are dead or do not exist.

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